The dimension of preventable stroke in a large representative patient cohort
Christian Boehme1, Thomas Toell1, Lukas Mayer-Suess1
1From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
Insights
Many patients with acute ischemic stroke or TIA have inadequately treated risk factors. Guideline-compliant therapy could prevent a significant number of stroke events.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Acute ischemic stroke and transient ischemic attack (TIA) pose significant health risks.
- Effective prevention strategies rely on managing modifiable risk factors.
Purpose of the Study:
- To analyze the frequency of inadequately treated risk factors in patients with acute ischemic stroke or TIA.
- To estimate the proportion of stroke events potentially preventable with guideline-compliant therapy.
Main Methods:
- Retrospective analysis of 1,730 patients from the STROKE-CARD trial (2014-2017).
- Assessment of 8 drug-amenable risk conditions and 3 lifestyle risk behaviors.
- Evaluation of pre-event risk factor control.
Main Results:
- 79.5% of patients had at least one inadequately treated risk condition, rising to 95.1% with lifestyle factors.
- Risk factor control was poorer in recurrent events, men, and younger patients (≤75 years).
- Adequate control of key factors could avert approximately 1 in 2 events.
Conclusions:
- A substantial gap exists between recommended and actual stroke risk factor control.
- Increased physician awareness of stroke preventability is crucial.
- This study provides a quantitative basis for improving stroke prevention strategies.
Objective:
To analyze the frequency of inadequately treated risk factors in a large representative cohort of patients with acute ischemic stroke or TIA and to estimate the proportion of events potentially avertable by guideline-compliant preventive therapy compared to the status quo.
Methods:
A total of 1,730 patients from the Poststroke Disease Management STROKE-CARD trial (NCT02156778) were recruited between 2014 and 2017. We focused on 8 risk conditions amenable to drug therapy and 3 lifestyle risk behaviors and assessed pre-event risk factor control in retrospect.
Results:
The proportion of patients with at least 1 inadequately treated risk condition was 79.5% (95% confidence interval [CI] 77.6%-81.4%) and increased to 95.1% (95% CI 94.1%-96.1%) upon consideration of the lifestyle risk behaviors. Risk factor control was worse in patients with recurrent vs first-ever events (p < 0.001), men vs women (p = 0.003), and patients ≤75 vs >75 years of age (p < 0.001). The estimated degree of stroke preventability ranged from 0.4% (95% CI 0.2%-0.6%) to 13.7% (95% CI 12.2%-15.2%) for the individual risk factors. Adequate control of the 5 most relevant risk factors combined (hypertension, hypercholesterolemia, atrial fibrillation, smoking, and overweight) would have averted ≈1 of 2 events or 1 in 4 with a highly conservative computation approach.
Conclusions:
Our study confirms the existence of a considerable gap between risk factor control recommended by guidelines and real-world stroke prevention. Our study intends to increase awareness among physicians about stroke preventability and provides a quantitative basis for the emerging discussion on how to best tackle this challenge.
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